WHO Regional Director for Africa Discusses Abuja Declarations

Dr. Luis Sambo, the World Health Organization’s Regional Director for Africa, spoke to global health professionals and African diplomats today at an event sponsored by the Center for Strategic and International Studies (CSIS), about progress made toward achieving goals in the Abuja Declarations made roughly a decade ago.

The first Declaration, signed in 2000 by many African heads of state, made commitments to reduce prevalence and consequently mortality from malaria by 50 percent by 2010. In a second Abuja Declaration, signed in April 2001, heads of states declared HIV/AIDS to be a matter of emergency.

African leaders resolved to place the fight against HIV/AIDS at the forefront of their respective national development plans, as well as consolidate the foundations for the prevention and control of the disease through a comprehensive, multisectoral strategy involving all development sectors of government. The leaders pledged to take more responsibility for the HIV/AIDS response, while also calling for an increase of external resources.

In addition, the Abuja Declaration removed all taxes, tariffs, and other economic barriers to access funding for HIV/AIDS related activities. Leaders also pledged to allocate 15 percent of their annual budgets to the improvement of health sectors. The Declaration called for improving the availability of medical products and technologies, as well as supporting the development of vaccines.

Sambo said not all of these goals have been achieved. For example, African nations on average allocate 6 percent of their budget to health sectors, instead of the pledged 15 percent, due in part to budget deficits.

But he also noted many successes in the fight against HIV. Since the Declaration, there has been an improvement in diagnostics, care and support, and prevention, and dramatically higher coverage of antiretroviral therapy. In 2002, only 2 percent of patients in need of treatment were receiving it; in 2008, that number jumped to 44 percent. HIV prevalence has dropped from 5.8 percent to 5.2 percent, and the rate of new infections has declined by 25 percent in that timeframe. And since 2004, the annual number of HIV-related deaths has fallen by 18 percent.

Sambo said much of these successes were achieved thanks to external funding mechanisms, such as PEPFAR and the Global Fund. He stressed that Global Fund and PEPFAR funds made significant contributions to change lives and provide hope. Sambo also expressed high hopes for President Obama’s new Global Health Initiative, and expects it to be a powerful initiative that will bring many positive results.

Despite these achievements, Sambo warned that not enough is being done and gaps in funding are allowing prevalence and mortality numbers to remain high. For every HIV patient being treated, three more are newly infected, he noted. Fifty- five percent of HIV infected pregnant women are not receiving ART prophylaxis, while 58 percent of all infected people have no access to ARV treatment. Life expectancy in the continent has dramatically shortened, with an average life expectancy of at least 60 years in the 1990s, to less than 50 years in 2010.

Sambo also stressed that HIV-TB co-infection continues to be an emerging problem, as the number of TB cases continues to increase and remains the leading cause of death among HIV patients. The emergence of MDR- and XDR-TB is making the HIV response even more difficult. Sambo expressed that the failure of integrating HIV and TB services has caused many of the difficulties, and that it’s difficult to achieve integration when two-thirds of funding needs for HIV-TB co-infection are unmet.

Health programs, he said, are receiving half of the funding needed for the HIV response. In total, Africa requires $12 billion to deal with the HIV/AIDS crisis, but is receiving $6 billion. He said $2 billion is required for the TB response, but $1 billion is available. In addition, he said $10 billion is needed for health systems strengthening, but African nations have $5 billion at their disposal.

But Sambo said funding wasn’t the only issue. He said African nations need to take on more responsibilities and ownership of programs, and broaden their health policies to go beyond disease control. In particular, he said, broader health determinants need to be addressed, such as poverty, lack of food security, lack of education, and environmental degradation.

He cited a need for increased support for maternal and child health, as well as a larger focus on women’s and girl’s development. Nations also need to develop capacity for health research and information systems. Most importantly, leaders need to make a renewed commitment to fighting the HIV epidemic, as well as use funds more efficiently.

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